Implant components and methods

ABSTRACT

Systems, devices, and methods are provided for orthopedic implants. The implants may include a base member, such as an acetabular shell or an augment, that is configured to couple with an augment, flange cup, mounting member, or any other suitable orthopedic attachment. A mounting member may be used to attach to an implant and anchor the implant to a patient&#39;s bone or soft tissue. The mounting member may be integral with the implant or may be provided as a separate component. A mounting member may be adjustably positionable around the implant to provide flexibility and allow the mounting member to meet needs of a particular patient and implant.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional PatentApplication No. 61/352,705, filed Jun. 8, 2010, U.S. ProvisionalApplication No. 61/352,722, filed Jun. 8, 2010, U.S. ProvisionalApplication No. 61/422,903, filed Dec. 14, 2010, and U.S. ProvisionalApplication No. 61/466,817, filed Mar. 23, 2011, which are herebyincorporated by reference herein in their entireties.

BACKGROUND

Joints often undergo degenerative changes due to a variety of reasons.When joint degeneration becomes advanced or irreversible, it may becomenecessary to replace the natural joint with a prosthetic joint.Artificial implants, including hip joints, shoulder joints, and kneejoints are widely used in orthopedic surgery. Specifically, hip jointprostheses are common. The human hip joint acts mechanically as a balland socket joint, wherein the ball-shaped head of the femur ispositioned within the socket-shaped acetabulum of the pelvis. Variousdegenerative diseases and injuries may require replacement of all or aportion of a hip using synthetic materials, typically metals, ceramics,or plastics.

More particularly, natural hips often undergo degenerative changes,requiring replacement of the hip joint with a prosthetic joint. Often,the hip is replaced with two bearing surfaces between the femoral headand the acetabulum. The first bearing surface is typically a prosthesisshell or acetabular cup, which may be formed of metal, ceramic material,or as otherwise desired. A liner (conventionally formed of polyethylenematerial such as ultra high molecular weight polyethylene, a ceramicmaterial, or in some cases, even a metal liner) is then fit tightlywithin the shell to provide an inner bearing surface that receives andcooperates with an artificial femoral head in an articulatingrelationship to track and accommodate the relative movement between thefemur and the acetabulum.

The cup (or a cup and liner assembly) is typically fixed either byplacing screws through apertures in the cup or by securing the cup withcement. In some cases, only a liner is cemented in a patient due to poorbone stock. In other cases, a cup having a porous surface may be pressfit into the reamed acetabular surface.

It may become necessary to conduct a second or subsequent surgery inorder to replace a prosthetic joint with a (often larger) replacementjoint. Such surgeries often become necessary due to further degenerationof bone or advancement of a degenerative disease, requiring removal offurther bone and replacement of the removed, diseased bone with a largeror enhanced prosthetic joint, often referred to as a revisionprosthesis. For example, bone is often lost around the rim of theacetabulum, and this may provide less rim coverage to securely place apress-fit cup. Such surgeries may thus be referred to as revisionsurgeries.

In acetabular revision surgery, an acetabular prosthesis generallyincludes additional mounting elements, such as augments, flanges, hooks,plates, or any other attachment or mounting points or members thatprovide additional support and/or stability for the replacementprosthesis once positioned. These additional mounting or attachmentmembers are often required due to bone degeneration, bone loss, or bonedefects in the affected area (in this instance, the hip joint).

Various types of these mounting members (which term is intended toinclude but not be limited to flanges, blades, plates and/or hooks) maybe provided in conjunction with a prosthesis system in order to help thesurgeon achieve optimal fixation, non-limiting examples of which includeiliac flanges (providing securement and fixation in and against theilium region of the pelvis), ischial blades (providing securement andfixation in and against the ischium), and obturator hooks (providingsecurement and inferior fixation by engaging the obturator foramen).Although there have been attempts to provide such mounting attachmentswith modularity, the solutions to date have generally fallen short ofproviding true modularity. Instead, they typically provide a fewdiscrete positions at which the mounting members may be positioned,without providing the surgeon a fuller range of decision options.

Additionally, in some primary surgeries and more often in revisionsurgeries, the acetabulum may have a bone defect or void that thesurgeon must fill with bone grafts before inserting a new shell. Thiscan be time consuming and expensive, and may subject the patient toadditional health risks. Some techniques use an augment in connectionwith the acetabular shell, which can be coupled to or otherwise attachedto the outer surface of the shell.

With current augments, the surgeon can attach the augment to the boneand then implant the cup. However, many acetabular shells rely on bonescrews to achieve proper fixation and the augment often gets in the wayof a screw. In short, surgeons need the freedom to place screws in thebest location, but this compromises their ability to use augments. Withcurrent systems, it also takes an increased amount of time surgical timeto trial the component orientation and then try to find good bonefixation for the cup. The surgeon will often have to free-hand theamount of bone removed while estimating the size of augment needed. Inthe cases where bone is often deficient, surgeons are hesitant to takeaway any more bone than necessary.

Various additional features and improved features intended for use andapplication with various types of joint implants are also describedherein, such as improved bone screws, improved coatings, and variousaugment removal and insertion options.

SUMMARY

Disclosed herein are systems, devices, and methods for providing modularorthopedic implants. The implants may include a base member, such as anacetabular shell or an augment, that is configured to couple with anaugment, flange cup, mounting member, any other suitable orthopedicattachment, or any combinations thereof. Mounting members include, forexample, flanges, blades, hooks, and plates. In some embodiments, theorthopedic attachments may be adjustably positionable about the basemember or other attachments thereby providing modularity for assemblingand implanting the device. Various securing and/or locking mechanismsmay be used between the components of the implant. In certainembodiments, the orthopedic attachments are removably coupled to thebase member or other components. In certain embodiments, the orthopedicattachments are integrally provided on the base member or othercomponents, yet may still be adjustably positionable thereabout. In someembodiments, expandable augments, base members, or other bone fillingdevices are provided. In some embodiments, surface features are providedthat create friction and allow for surrounding bone ingrowth at theinterface of the implants and a patient's bone.

Systems, devices, and methods described herein provide implants havingattachment mechanisms that provide a plurality of positioning optionsfor the orthopedic attachments. In certain embodiments, an orthopedicdevice includes an implant structured to fit with and stabilize apatient's orthopedic joint, the implant having a plurality of attachmentsites, and a mounting member having a first end that anchors to thepatient's bone or soft tissue and a second end that mates with theimplant at each of the plurality of attachment sites. The plurality ofattachment sites can include portions of a crossbar extending about anacetabular shell. Alternatively or additionally, the attachment sitescan include a groove extending along a rim of the implant. In someembodiments, attached mounting members may include conventional holes,locking holes, or slots. The sites may be threaded, unthreaded, orpartially threaded, and may be fixed or polyaxial. In some embodiments,attachment sites may include variable low-profile holes that allow forlocking at a variety of angles. In some embodiments, a porous surface isdisposed on a portion of the mounting member. In some embodiments, themounting member is a flange that is adjustably positionable about thecircumference of an acetabular implant. For example, the flange (or anyother suitable mounting member) can pivot in a plane that isperpendicular to the circumference of an acetabular shell. The flangecan include a split eye-let and/or a hook that joins a rail or groove onthe implant. The flange can also include a key that removably insertswithin a complementary rim on an acetabular shell. In certainembodiments, the flange is a flexible strap, or the flange may include afrangible portion that allows the flange to bend or break. In certainembodiments, the implant includes an annular recessed slot with anoverhanging lip, where the mounting member includes a distal portionthat fits within the annular recessed slot. The implant can be anaugment that mounts to a surgical shell or cage, and the implant can fitwithin one of a shoulder, hip, or ankle joint. In certain embodiments,the mounting member includes a plurality of flanges, at least one flangebeing adjustably positionable with respect to more than one of theattachment sites.

In certain embodiments, a method of installing an orthopedic implantwithin a patient includes the steps of inserting the implant into thepatient, selecting a site along the inserted implant to receive a firstmounting member, attaching the first mounting member to the selectedsite, and anchoring the first mounting member to the patient. Theselected site may be chosen from a plurality of attachment sites thatare angularly spaced about the implant. The method may further includethe step of applying a porous surface to a portion of the first mountingmember. In some embodiments, the inserting step may include the step ofmounting an acetabular shell or cage within the patient's acetabulum. Insome embodiments, the implant may be an acetabular augment, and theinserting step may include the step of mounting the acetabular augmentto an acetabular shell. The method may further include the step ofdetaching a detachable portion of the first mounting member afterattaching the first mounting member to the selected site. In someembodiments, the anchoring step includes the step of anchoring the firstmounting member to a first entry point within the selected site. Themethod may further include the step of cementing the implant into thepatient's acetabulum prior to attaching the first mounting member to theselected site. The method may further include the step of adjustablypositioning the mounting member about the circumference of the implantand along the selected site. In some embodiments, the mounting membermay include a flange, hook, or plate.

In certain embodiments, mounting members or augments shown and describedin the figures contained herein may comprise tacks, spikes, coatings, ortextured surfaces so as to improve initial fixation. The geographiclocations of tacks, spikes, coatings, or textured surface structures maybe strategically placed on select portions of a mounting member orimplant so as to evenly load the mounting member or implant assembly andobtain the best biologic response initially, and over an extended periodof time.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other objects and advantages will be apparent uponconsideration of the following detailed description, taken inconjunction with the accompanying drawings, in which like referencecharacters refer to like parts throughout, and in which:

FIGS. 1-4 show various perspectives of an illustrative rim augment ormounting member;

FIGS. 5 and 6 schematically show the use of an illustrative pivot jointto add a mounting member to an acetabular shell;

FIG. 7 shows an illustrative mounting member having a hook that receivesa crossbar;

FIG. 8 shows an illustrative mounting member having a split opening thatreceives a crossbar;

FIG. 9 shows an illustrative T-slot into which a correspondingly-shapedreceiving portion may be disposed;

FIG. 10 shows a plurality of illustrative entry portions that may beprovided around an acetabular shell;

FIGS. 11-13 show an illustrative augment having one or more mountingmembers;

FIGS. 14-19 show one or more illustrative porous pieces or surfacesprovided on bendable mounting members such as bendable flanges orplates;

FIG. 20 shows an illustrative mounting member having peripheral notchesor inlets;

FIG. 21 shows an illustrative mounting member having cross-hatches orremoved material from the surface;

FIGS. 22 and 23 show illustrative mounting members having variousreduced surface area portions;

FIG. 24 shows an illustrative mounting member having one or more porousareas that are spaced out on the member;

FIG. 25 shows a mounting member having an illustrative orthopedic mesh;

FIG. 26 shows an illustrative mesh portion placed on an outer portion ofa shell;

FIG. 27 shows an illustrative mesh that includes a plurality of trimlines that may be cut to separate the mounting members attached thereto;

FIG. 28 shows illustrative separated mounting members from the mesh ofFIG. 27 placed into a patient's hip region;

FIGS. 29 and 30 show an illustrative honeycomb design that may beprovided on a mounting member or augment;

FIG. 31-34 show illustrative cleats provided proximate to a rim of anacetabular shell or cage, mounting member, or augment;

FIG. 35 shows illustrative cleat portions configured for securing softtissues;

FIGS. 36 and 37 show an illustrative augment attached peripherally to anacetabular shell or cage via a recess;

FIGS. 38 and 39 show an illustrative mounting member attachedperipherally to an acetabular shell or cage via a recess; and

FIG. 40 shows an acetabular shell or cage having an illustrative annularprotrusion.

DETAILED DESCRIPTION

To provide an overall understanding of the systems, devices, and methodsdescribed herein, certain illustrative embodiments will be described.Although the embodiments and features described herein are specificallydescribed for use in connection with acetabular systems, it will beunderstood that all the components, connection mechanisms, adjustablesystems, fixation methods, manufacturing methods, coatings, and otherfeatures outlined below may be combined with one another in any suitablemanner and may be adapted and applied to medical devices and implants tobe used in other surgical procedures, including, but not limited to:spine arthroplasty, cranio-maxillofacial surgical procedures, kneearthroplasty, shoulder arthroplasty, as well as foot, ankle, hand, andother extremity procedures.

Various implants and other devices described herein in their variousembodiments may be used in conjunction with any appropriatereinforcement material, non-limiting examples of which include bonecement, appropriate polymers, resorbable polyurethane, and/or anymaterials provided by PolyNovo Biomaterials Limited, or any suitablecombinations thereof. Further non-limiting examples of potentialmaterials that may be used are described in the following references:U.S. Patent Application Publication No. 2006/0051394, entitled“Biodegradable Polyurethane and Polyurethane Ureas,” U.S. PatentApplication Publication No. 2005/0197422, entitled “BiocompatiblePolymer Compositions for Dual or Multi Staged Curing,” U.S. PatentApplication Publication No. 2005/0238683, entitled “BiodegradablePolyurethane/Urea Compositions,” U.S. Patent Application Publication No.2007/0225387, entitled “Polymer Compositions for Dual or Multi StagedCuring,” U.S. Patent Application Publication No. 2009/0324675, entitled“Biocompatible Polymer Compositions,” U.S. Patent ApplicationPublication No. 2009/0175921, entitled “Chain Extenders,” and U.S.Patent Application Publication No. 2009/0099600, entitled “High ModulusPolyurethane and Polyurethane/Urea Compositions.” Each of the priorreferences is incorporated by reference herein in its entirety.

FIGS. 1-4 show some embodiments where a rim augment or a mounting membermay be configured for a left hip. Rim mounting member 202 may bepress-fit onto an outer diameter 203 of an acetabular cup 204 (e.g.,acetabular shell, cup, cage, or augment). The rim mounting member 202has at least one curved or spherical inner surface 205 that matches acontour profile 207 of an outer surface of the acetabular cup 204 towhich the mounting member 202 is attached. In some embodiments, morethan one opposing curved or spherical surfaces may be provided on theinner surface 205 of the rim mounting member 202, each curved orspherical surface comprising a similar radius of curvature. The size,shape, and profile of these one or more curved or spherical surfacescorrespond to the outer diameter and outer surface profile of theacetabular cup 204.

By providing two curved or spherical surfaces, for example, the rimmounting member 202 may be configured for universal use and, therefore,may be flipped or inverted in order to allow its use with a left to aright acetabular cup. In other words, the rim mounting member 202 may beinverted when used in conjunction with a contralateral hip. It mayfurther be provided in any suitable number of available sizes in orderto fit multiple cup sizes (e.g., acetabular cups having outer diametersizes ranging between approximately 30 mm and 90 mm).

One or more flanges or other mounting members, or any combinationsthereof, may be provided on mounting member 202. In the particularembodiment shown, three mounting members 208 are shown, which extendradially from the rim of the acetabular cup 204. The mounting members208 are configured to be bent, cut, or otherwise shaped as needed inorder to conform to the pelvis of a particular patient's anatomy.Alternatively or additionally, one or more of the mounting members 208may be oriented at predetermined radial locations circumferentiallyaround the rim of the acetabular cup to correspond with, engage, orotherwise accommodate the ilium, ischium, superior ramus, or any othersuitable patient anatomy. It should further be understood that any ofthe alternate and adjustable mounting and securement mechanismsdescribed herein may also be used with these embodiments. The describedrim mounting members are of particular use in acetabulums having defectsand damage along the acetabular rim. The holes of the mounting members208 may be threaded, unthreaded, or partially threaded, and may be fixedor polyaxial. In some embodiments, attachment sites may include variablelow-profile holes that allow for locking at a variety of angles.

FIGS. 5-8 schematically illustrate the use of a pivot joint 210 to add amounting member (such as a flange, plate, or any other attachment ormounting member) to an acetabular shell, cup member, or augmentaccording to some embodiments. For example, as shown in FIG. 5, acrossbar 212 may be provided in one or more recesses 214 on an uppershell surface of proximal rim portion 216 of the acetabular shell 218and aligned generally parallel to a tangent of the shell 218 adjacentits rim. The one or more recesses 214 may comprise, for instance, aV-shaped slot, although any other suitably-shaped slot may be used. Aplurality of attachment sites may be provided, with each being spacedangularly about the rim or other portion of the implant. This allows aplurality of positioning options for mounting members and gives thesurgeon more flexibility to position the attachments along the implantfor ease of anchoring. The acetabular shell 218 includes a ridge 230 oninner surface 228 that mates with a correspondingly-shaped ridge of aliner, for example, although any other suitable mounting member oraugment may have a similarly-shaped ridge for mating with ridge 230. Insome embodiments, the ridge 230 may be provided alternatively, oradditionally, on outer surface 226.

A mounting member 220 has a first end 221 that anchors to the patient'sbone or soft tissue and a second end or receiving portion 223 that mateswith the implant, such as acetabular shell 218, at each of the pluralityof attachment sites provided along, for example, the crossbar 212. Thesecond end or receiving portion 223 of mounting member 220 may have ahook or a split opening that receives the crossbar 212. For example,mounting member 220′ of FIG. 7 includes a hook 222, and mounting member220″ of FIG. 8 includes a split opening 224, which may also be referredto as a split eyelet. The mounting members shown in FIGS. 6-8 may bemoved independently of the shell positioning. One of the advantagesprovided by this design is that the flanges and other mounting membersare completely modular and do not have to be positioned in the samediscrete place or in only one of a few pre-determined locations, but caninstead be positioned anywhere around the rim of the shell and can pivotin a plane that is perpendicular to the plane defined by thecircumference of the shell.

FIGS. 9 and 10 illustrate some embodiments where one or more mountingmembers and/or augments translate or ride, or otherwise move, in acircumferentially-extending T-slot, dovetail slot, tongued groove, orundercut groove provided in an outer shell surface 244 proximate to therim. The mounting members or augments may be configured with a receivingportion that may enter a portion of the shell 246 and slide within thecircumferentially-extending T-slot, dovetail slot, tongued groove, orundercut groove. For example, FIG. 9 shows a T-slot 240 on an outersurface 244 of shell 246 into which a correspondingly-shaped receivingportion may be disposed. The mounting members or augments can revolvearound the shell to the proper angular position around the rim and thenbe locked, retained, or otherwise secured in position. For example, thereceiving portions may include a locking member or an expanding memberthat locks or expands, respectively, when the mounting member or augmentis place in a particular location along the shell to thereby secure themounting member or augment into position. A plurality of attachmentsites may be provided, with each being spaced angularly about the rim orother portion of the implant. This allows a plurality of positioningoptions, as opposed to the discrete few options typically provided, forexample, where the mounting member or augment must be positioned at thediscrete location where attached. Similar to the acetabular shell 218 ofFIG. 5, shell 246 may also include a ridge 248 on inner surface 242 thatmates with a correspondingly-shaped ridge of a liner, for example,although any other suitable mounting member or augment may have asimilarly-shaped ridge for mating with ridge 248. In some embodiments,the ridge 248 may be provided alternatively, or additionally, on outersurface 244.

One or more entry points may be provided within the T-slot, dovetailslot, tongued groove, undercut groove, or other attachment site to allowquick insertion, placement, access, or removal of the flanges, plates,or augments with respect to the shell. Particularly, multiple entryportions may be configured to allow one or more mounting members oraugments to be engaged with the shell and positioned angularly aroundthe shell even after the shell has been impacted into a preparedacetabulum and portions of the shell proximate to the rim are obstructedby bone, grafts, or cement. For example, as shown in FIG. 10, aplurality of entry portions 254 may be provided around shell 258. Amounting member 250 that includes a receiving portion 252 shaped as akey may be engaged with a reciprocally-shaped groove 256 at one of entryportions 254. The mounting member 250 may engage with the shell byplacing mounting member 250 into one of the grooves 256 at an entrypoint 254 and then positioned angularly around the shell therefrom toone of a plurality of attachment sites. Furthermore, mounting member 250may be inserted into a first entry point 254, rotated about the shell258 to a second entry point 254, and then removed.

In the embodiments shown in FIGS. 11-13, one or more mounting members262 (shown as flanges, but not limited thereto) are added to anacetabular augment 260. The mounting members 262 may be permanentlyfixed or detachable, and may be adjustably positionable about augment260 as described above. Mounting members 262 may have frangible portions264 between screw holes 266 or other structures for receiving fasteners.The frangible portions 264 may be provided, for example, as reducedcross-sections that allow bending or breaking or cutting of the mountingmembers 262 without disturbing the internal geometries of the screwholes 266. In certain embodiments, the frangible portions 264 may beprestressed or otherwise pretreated to make the frangible portions 264weaker than other areas of the mounting members 262. Screw holes 266 maybe smooth or provided with threads or other protrusions to be used withlocking head screws or polyaxial screws. The screw holes 266 may beconventional holes, locking holes, or slots. The holes may be threaded,unthreaded, or partially threaded, and may be fixed or polyaxial. Insome embodiments, screw holes 266 may include variable low-profile holesthat allow for locking at a variety of angles. The augment 260 andmounting members 262 may be implanted proximate a patient's acetabulum.For example, as shown in FIGS. 12 and 13, augment 260 having mountingmembers 262 is implanted into an area having a posterior column defectregion 268.

As shown in the embodiments depicted in FIGS. 14-19, one or more porouspieces or surfaces may be provided on bendable mounting members such asbendable flanges or plates, or any of the other mounting members. Insome instances, solid or rigid augments may replace bendable mountingmembers. The mounting members may be modular, attachable, orintegrally-provided on an acetabular implant structure such as anacetabular shell. As shown in FIG. 14, a mounting member 280 includes aporous coating 282 about a periphery while top portion 284 issubstantially smooth and flat. Mounting member 280 also includes aplurality of fastening through-holes 286 for receiving screws or otherfastening members. Through-holes 286 may include conventional holes,locking holes, or slots. The holes may be threaded, unthreaded, orpartially threaded, and may be fixed or polyaxial. In some embodiments,through-holes 286 may include variable low-profile holes that allow forlocking at a variety of angles. Exemplary bending motion of flanges isshown with respect to FIGS. 15 and 16. A mounting member such as flange290 has a first portion 291 and a second portion 292 and is flat. Flange294 may be bent in a first direction about bending axis 295 such that asecond portion 298 is bent relative to a first portion 296. Because insome instances there may be a chance that porous structures integrallyprovided on mounting members (such as porous coating 282 of FIG. 14) mayfracture, delaminate, or separate from the mounting members during orafter bending, porous pieces may be provided separate from and/or spacedbetween securement devices such as screw holes, as shown in FIG. 17 andFIG. 19. In FIG. 17, a separate porous in-growth pad 306 is provided,which can be secured to a bendable mounting member 300 via screw 304, sothat the bendable mounting member 300 may still be bent, while alsofeaturing the desired in-growth advantages of the porous in-growth pads306, without being subject to delamination or decoupling upon bending.This allows bending of the mounting members without stressing the strutsof each porous piece. The porous piece may be positioned before or afterbending. Screws 302 may be provided for securing the mounting member 300to a patient's bone or soft tissue, an acetabular shell, augment, orother mounting member.

In lieu of screw holes, or in addition to screw holes, in someembodiments spikes, tacks, or other appropriate fasteners may beutilized. J-slots may be provided in the porous pieces or the mountingmembers to allow adjustability of the position of the porous piecerelative to the augment or mounting member in both rotation andtranslation. For example, FIG. 18 shows a mounting member 270 having aplurality of screw holes 272 and J-slots 274. Screws or any appropriatefixation members may be used to rigidly fix the porous pieces to theaugment or mounting member, or other members such as shape memory ordeformable pegs (e.g., rivet structure) may be used to rigidly fix theporous pieces to the augment or mounting member. In some instances,members fixing the porous pieces to the augment or mounting member maybe configured to allow the porous pieces to move during bending of themounting members.

As shown in FIG. 19, a mounting member 310 includes a first portion 312that is bent in a first direction about bending axis 320 relative to asecond portion 314. The first portion 312 and second portion 314 ofmounting member 310 each include J-slots 316 to allow adjustability ofthe position of the porous pieces 318 attached thereto relative tomounting member 310.

FIGS. 20-24 show various embodiments of adjustable and/or flexiblemounting members. Stiff mounting members, such as stiff plates orflanges, or any other suitable stiff members that may be used to extendfrom a surgical implant for securing it into place, may be difficult tobend or position. It may thus be desirable in some instances to providemounting members that are configured to bend or otherwise adjust.

FIG. 20 shows a mounting member 340 having peripheral notches or inlets342 cut into the profile of the mounting member 340. In someembodiments, these features allow mounting member 340 to be flexed,bent, shaped, or otherwise contoured to bone or around other devices. Inthe embodiment shown, the notches 342 are Z-shaped, but it will beunderstood that any appropriate shape, such a J-slots, C-slots, V-slots,any other appropriate shapes, or any combinations thereof, may be used.FIG. 21 shows a mounting member 350 having cross-hatches or removedmaterial 352 from the surface, thereby reducing the cross-sectionalsurface area of the member. These features may make it easier formounting member 350 to flex, bend, shape, or contour. FIGS. 22 and 23show further embodiments of mounting members that may have variousreduced surface area portions, such as notches, indents, removedmaterial, cut outs, or other portions of reduced surface area, or anycombinations thereof. For example, mounting member 360 includes notches362 and cross-hatches or removed material 364. These reduced surfacearea portions may have any appropriate profile or cross-sectional shape,examples of which may be circular, curved, triangular,irregularly-shaped or any other appropriate option. The reduced surfacearea portions may help enhance the flexibility or bendability of themember.

FIG. 24 shows a mounting member 370 having one or more porous areas 372that are spaced out on the member 370. In certain embodiments, themounting member 370 may be bent or otherwise configured as desired,without being limited by the porous areas, as discussed above inconnection with FIGS. 14-19. For example, mounting member 370 may bebent about region 374 or 376 without introducing bending stresses to theporous areas 372 or substantially limiting the bending stresses onporous areas 372. Mounting member 370 may have any of theabove-discussed reduced surface area portions, or mounting member 370may be provided as a typical, traditional mounting member.

In the embodiments shown in FIGS. 25-28, one or more mounting membersand/or augments may be integrally provided with orthopedic mesh todefine one or more mesh mounts or void fillers. FIG. 25 shows a mountingmember 380 having an orthopedic mesh 382. In FIG. 26, the orthopedicmesh portion 382 may be placed on an outer portion 384 of the shell 386between bone, and a cement mantle can fill between the mesh 382. Thecement mantle rigidly connects the mounting member 380 (or, in someembodiments, an augment) to the shell 386 via the surgical mesh 382.Rapid manufacturing techniques may be used to simultaneously create themounting members or augments integrally with the orthopedic meshportion. The mesh 382 may be honeycomb, diamond, or other weave pattern,or any combination thereof, and may come in multiple thicknesses. Meshportion 382 may be oversized, customized for an individual patient,and/or standardized and trimmed by the surgeon to fit a particularpatient's needs. Fasteners of all types may be inserted through one ormore cells of the mesh 382, as well as through the one or more mountingmembers or augments to further secure the implant to bony anatomy. Forexample, as shown in FIG. 25, a first screw 388 may be inserted throughcell 390, and a second screw 394 may be inserted through one of theplurality of screw holes 392 of mounting member 380. Screw holes 392 mayinclude conventional holes, locking holes, or slots. The holes may bethreaded, unthreaded, or partially threaded, and may be fixed orpolyaxial. In some embodiments, screw holes 392 may include variablelow-profile holes that allow for locking at a variety of angles. Softtissues may be reattached using the porosities of the mesh 382 as sutureanchors, or simply as a bioscaffold. If desired, preformed trim linesmay be provided by forming predetermined frangible portions in variousareas of the mesh, in order to help configuration of the device for aparticular patient. For example, as shown in FIG. 27, mesh 400 includesa plurality of trim lines 402 that may be cut to separate the mountingmembers attached thereto, such as mounting members 404. The separatedmounting members 404 and the mesh 400 may then be placed into apatient's hip region 406 as shown in FIG. 28.

FIGS. 29 and 30 illustrate some embodiments of a honeycomb design thatmay be provided on a mounting member or augment in order to controlcement mantle thickness and spacing between said mounting member oraugment and an adjacent acetabular shell, augment, bone, or otherimplant. For example, mounting member 410 of FIG. 29 includes honeycombportion 412 provided on an attachment surface portion 414 of themounting member 410. The honeycomb feature 412 may be provided as anydesired geometric shape. The mounting member 410 (or, in someembodiments, the augment) may comprise one or more securing holes 416for receiving a surgical fastener 418 such as a polyaxial screw,cancellous screw, peg, or other securing device. The securing holes 416may include conventional holes, locking holes, or slots. The holes maybe threaded, unthreaded, or partially threaded, and may be fixed orpolyaxial. In some embodiments, securing holes 416 may include variablelow-profile holes that allow for locking at a variety of angles. Theattachment portion 414 of the mounting member 410 may extend generallyperpendicularly from another portion 415 of the mounting member 410, andmay comprise one or more concave curved surfaces 417 configured to abutan outer portion 422 of an acetabular shell 420, or one or more convexsurfaces (not shown) configured to abut an inner portion of a preparedacetabulum.

In the embodiments shown in FIGS. 31-34, cleats may be providedproximate to a rim of an acetabular shell, cage, mounting member, oraugment. For example, in some embodiments, one or more cleats 780 and781 may extend or project from a superior aspect of a rim portion 782 ofan acetabular shell 784 as shown. Cleats 780 and 781 may be used tosecure soft tissues to the acetabular shell 784 or may serve as a meansto attach secondary augments or any type of mounting member 786 to theacetabular shell 784. In the particular instance shown in FIGS. 33 and34, a “quarter-turn” fastener connector arrangement is utilized. Thequarter-turn fastener arrangement may comprise, for instance, agenerally T-shaped male member 790 located on one or more regions of anacetabular shell, cage, or augment, and one or more complementary femalemembers 792 located on more secondary augments or mounting members. Theone or more secondary augments or mounting members engage the one ormore male members 790 on the acetabular shell, cage, or augment in onedegree of rotation, and then are rotated by a specified or variablenumber of degrees (e.g., 90 degrees) to lock the one or more secondaryaugments or mounting members to the one or more male members 790. Ofcourse, one of ordinary skill in the art would appreciate that the maleand female members could be reversed to provide the same function. Itshould also be understood that other locking mechanisms may be used.

FIG. 35 further depicts one or more cleat portions 794 located atvarious portions of an acetabular shell or cage 796 (or, in someembodiments, an augment) configured for securing soft tissues. The oneor more cleat portions 794 can be arranged in any particular fashionaround the acetabular shell 796; however, it is preferred that thecleats 794 extend proximally from a rim portion or otherwise away fromthe acetabular shell 796 in order to provide clearance from liner-matingsurfaces, cement mantle surfaces, bone contacting surfaces, and bonyanatomy, for example. Cleat portions 794 may comprise suturing holes,roughened surfaces, clamps, hooks, or biologic coatings, or any otherappropriate protrusions, or combinations thereof, to encourage fixationof the soft tissues to the implant (e.g., acetabular shell 796). Forexample, as shown in the inset of FIG. 55, sutures may be wrapped aroundcleat portion 794 and then secured to surrounding soft tissues.

FIGS. 36-40 illustrate embodiments wherein a mounting member 802 or anaugment 804 may be attached peripherally to an acetabular shell or cage806 via a recess 800 provided proximate a rim portion 808 of theacetabular shell or cage 806. The recess 800 is sized to accept aprotruding insertion portion 810 of the mounting member 802 or aprotruding insertion portion 812 of the augment 804, and the recess 800may extend annularly circumferentially around the rim portion 808 toallow orbital placement of the mounting member 802 or augment 804 arounda periphery of the shell or cage 806. The mounting member 802 or augment804 may be inserted into the acetabular shell or cage 806 before orafter shell/cage impaction or cementing into a prepared acetabulum. Oneor more screw holes in the mounting member (e.g., screw holes 814) oraugment (e.g., screw holes 816) rigidly secure the mounting member 802or augment 804 to the bone and prevent orbital movement of the mountingmember 802 or augment 804 around the shell or cage 806. Screw holes 814and 816 may include conventional holes, locking holes, or slots. Theholes may be threaded, unthreaded, or partially threaded, and may befixed or polyaxial. In some embodiments, screw holes 814 and 816 mayinclude variable low-profile holes that allow for locking at a varietyof angles. Once the mounting member 802 or augment 804 is positioned,the cantilever force pushes the rim 808 of the shell or cage 806 towardbone. The protruding insertion portion of the mounting member (e.g.,portion 810) or augment (e.g., portion 812) provides a hold-down forceto the shell or cage 806 after a screw is inserted through the mountingmember 802 or augment 804 and into surrounding pelvic bone.

FIGS. 36 and 37 show an augment 804 being positioned with respect to anacetabular shell or cage 806. FIGS. 38 and 39 illustrate a mountingmember 802 being positioned with respect to an acetabular shell or cage806. The mounting member 802 is shown as having multiple securing holes814 for use with fasteners. Securing holes 814 may be smooth, tapered,or threaded and may be used with any appropriate fastener, including butnot limited to polyaxial screws. The securing holes 814 through themounting member 802 (or securing holes 816 through the augment 804) maybe positioned at any appropriate angle, as shown, such as parallel tothe member, oblique through the member, or otherwise as desired. Whilenot shown, a honeycomb feature may be placed on outer portions of themounting member 802 or augment 804 to provide spacing for a cementmantle between the mounting member 802 or augment 804 and surroundingbone. Moreover, porous structures, textured surfaces, biologic coatings,or orthopedic meshes may be integrally provided on, or incorporatedbetween outer surfaces of the mounting members 802 or augments 804 andsurrounding bone.

In the embodiments of FIGS. 38 and 39, a recess 800 in the shell or cage806 is defined by a proximally-extending lip 818 such that the mountingmember 802 will sit on bone surrounding the acetabulum. In this way, themounting members 802 will not interfere with the press-fit area betweenthe shell 806 and prepared acetabulum adjacent the acetabular rim 808.Moreover, because the connection is configured to allow mounting members802 to sit on surrounding bone, the surrounding bone does not need to becountersunk or otherwise prepared to receive mounting members 802.

FIG. 40 depicts an acetabular shell or cage 820 comprising an annularprotrusion 822 along a rim portion 824 of the acetabular shell 820. Theannular protrusion 822 may extend partially around (as shown) orentirely around the circumference of the acetabular shell 820, or one ormore protrusions may be provided in any fashion around the acetabularshell 820. The annular protrusion 822 may comprise an annular lip 826defining an annular undercut groove 828 running circumferentially aroundthe acetabular shell 820 proximate the rim portion 824. The annularprotrusion 822 may comprise one or more openings 830 for receivingsutures (e.g., for soft tissue or capsule re-attachment) or fasteners832 such as set screws for contacting and frictionally engaging surfaces(e.g., divots) provided on protruding insertion portions 834 and 836 ofmounting members 840 or augments 838 alike.

Fasteners 832 may be inserted into openings 830 locatedcircumferentially laterally of the insertion portions 834 and 836 toserve as stops for preventing or limiting rotational movement of theattached mounting members 840 or augments 838. The mounting members 840or augments 838 may be secured down to surrounding bone after beinginserted into the annular undercut groove 828 via long bone screws,thereby providing a hold-down force to the acetabular shell or cage 820.The hold-down forces provided may complement the press fit, threadedfit, or cemented fixation between the acetabular shell or cage andsurrounding prepared acetabular bone. In the instance shown, shell 820is provided as a “hooded” shell similar to a cage, and may act as abuttress for a cemented or pressed-in liner to support various linerinclinations in varying degrees of acetabular or pelvic degradation,although it will be understood that these features may be provided onany other type of shell or cage.

The foregoing is merely illustrative of the principles of thedisclosure, and the systems, devices, and methods can be practiced byother than the described embodiments, which are presented for purposesof illustration and not of limitation. It is to be understood that thesystems, devices, and methods disclosed herein, while shown for use inacetabular systems, may be applied to medical devices to be used inother surgical procedures including, but not limited to, spinearthroplasty, cranio-maxillofacial surgical procedures, kneearthroplasty, shoulder arthroplasty, as well as foot, ankle, hand, andextremities procedures.

Variations and modifications will occur to those of skill in the artafter reviewing this disclosure. The disclosed features may beimplemented, in any combination and subcombinations (including multipledependent combinations and subcombinations), with one or more otherfeatures described herein. The various features described or illustratedabove, including any components thereof, may be combined or integratedin other systems. Moreover, certain features may be omitted or notimplemented.

Examples of changes, substitutions, and alterations are ascertainable byone skilled in the art and could be made without departing from thescope of the information disclosed herein. All references cited hereinare incorporated by reference in their entirety and made part of thisapplication.

1. An orthopedic device comprising: an implant structured to fit withand stabilize a patient's orthopedic joint, the implant having aplurality of attachment sites; and a mounting member having a first endthat anchors to the patient's bone or soft tissue and a second end thatmates with the implant at each of the plurality of attachment sites. 2.The device of claim 1, wherein the plurality of attachment sites includeportions of a crossbar extending about an acetabular shell.
 3. Thedevice of claim 1, wherein the plurality of attachment sites includeportions of a groove extending along a rim of the implant.
 4. The deviceof claim 1, wherein the mounting member is a flange.
 5. The device ofclaim 4, wherein the flange is adjustably positionable about thecircumference of an acetabular implant.
 6. The device of claim 5,wherein the flange includes a split eyelet that joins a rail or grooveon the implant.
 7. The device of claim 5, wherein the flange includes ahook that joins a rail or groove on the implant.
 8. The device of claim5, wherein the flange includes a key that removably inserts within acomplementary rim on an acetabular shell.
 9. The device of claim 4,wherein the flange pivots in a plane that is perpendicular to thecircumference of an acetabular shell.
 10. The device of claim 4, whereinthe flange is a flexible strap.
 11. The device of claim 4, wherein theflange includes a frangible portion that allows the flange to bend orbreak.
 12. The device of claim 1, wherein the implant includes anannular recessed slot with an overhanging lip, and wherein the mountingmember includes a distal portion that fits within the annular recessedslot.
 13. The device of claim 1, wherein the implant is an augment thatmounts to a surgical shell or cage.
 14. The device of claim 1, whereinthe implant fits within one of a shoulder, hip, or ankle joint.
 15. Thedevice of claim 1, wherein the mounting member includes a plurality offlanges, at least one flange being adjustably positionable with respectto more than one of the attachment sites.
 16. The device of claim 1,comprising a porous surface disposed on a portion of the mountingmember.
 17. A method of installing an orthopedic implant within apatient, comprising the steps of: inserting the implant into thepatient; selecting a site along the inserted implant to receive a firstmounting member; attaching the first mounting member to the selectedsite; and anchoring the first mounting member to the patient.
 18. Themethod of claim 17, further comprising the step of applying a poroussurface to a portion of the first mounting member.
 19. The method ofclaim 17, the inserting step comprising the step of mounting anacetabular shell or cage within the patient's acetabulum.
 20. The methodof claim 17, wherein the implant is an acetabular augment.
 21. Themethod of claim 20, wherein the inserting step comprises the step ofmounting the acetabular augment to an acetabular shell.
 22. The methodof claim 21, further comprising the step of detaching a detachableportion of the first mounting member after attaching the first mountingmember to the selected site.
 23. The method of claim 17, wherein theselected site is chosen from a plurality of attachment sites that areangularly spaced about the implant.
 24. The method of claim 17, whereinthe anchoring step includes the step of anchoring the first mountingmember to a first entry point within the selected site.
 25. The methodof claim 17, further comprising the step of cementing the implant intothe patient's acetabulum prior to attaching the first mounting member tothe selected site.
 26. The method of claim 17, further comprising thestep of adjustably positioning the mounting member about thecircumference of the implant and along the selected site.
 27. The methodof claim 26, wherein the mounting member comprises a flange, hook, orplate.